Compression screw system

ABSTRACT

A compression screw comprising a threaded shaft and a head associated with the proximal end of the shaft. The head has a plurality of outwardly extending projections spaced from one another so as to define a plurality of recesses there between for receiving a screw drive in such a way that rotational force may be transferred from the screw drive to the screw. The projections of the head may be provided with suture fixation holes or a suture coupling may be positioned over the shaft so as to extend between the projections of the head.

INCORPORATION BY REFERENCE

The entirety of U.S. provisional application Ser. No. 61/589,947, filedon Jan. 24, 2012, is hereby expressly incorporated herein by reference.

BACKGROUND

The inventive concepts disclosed herein generally relate to implantablecompression screws, and more particularly, but not by way of limitation,to a compression screw system with suture anchoring features and tomethods of using same.

Implantable compression screws are typically used to manage bonefractures, for example, by implanting a compression screw into afractured bone, such that the screw fixes, or compresses, fractured bonefragments against one another, thus allowing the bone to heal andre-grow. In certain fractures, an external plate may be compressedagainst the bone, typically by more than one compression screw, in orderto reinforce the bone and allow it to heal.

Soft tissues, such as tendons and ligaments, are generally attached tobone by small collagenous fibers. These fibers are strong, but permitthe tendons and ligaments to be flexible. Some fractures, or other boneinjuries, result in soft tissue being torn away or detached from thebone and requiring repair. Surgeons are often required to repair thedetached soft tissue with one or more sutures which typically reattachthe soft tissue to the bone via a suture anchor implanted into the bone.Such suture anchors are usually implanted into a patient's bone throughextensive surgical procedures or through arthroscopic surgicaltechniques. Generally, some suture anchors may require a surgeon to tiea knot in the suture, or may be “knotless,” i.e., no knot is required tosecure the soft tissue to the bone because the suture is retained by thesuture anchor and the bone.

Existing compression screws are implanted into a patient's bone in anumber of ways, which can generally be classified as those that requiredrilling of a hole in the bone, and those that can be implanted withoutdrilling, such as by being pushed-in or screwed-in the bone, forexample. Some compression screws include threaded tips that areself-tapping, and some compression screws require that a hole or achannel be drilled or formed into the bone prior to implanting thecompression screw into the bone.

Once a compression screw is implanted, adjacent soft tissues, such asmuscles, tendons, cartilage, and skin, for example, may move over thehead of the compression screw as a result of normal body movements ofthe patient. Currently available compression screws have bulky heads,which protrude over the surface of the bone and may cause soft-tissueabrasion, irritation, and damage, for example. Further, as the bonesurfaces surrounding the compression screw typically have varyingangles, the head of prior art compression screws may not sit level withthe surface of the bone, thus causing further irritation and injury toadjacent soft tissues.

While some variable-angle compression screws have been developed in theprior art, such variable angle compression screws still have the abovedisadvantages (see for example U.S. patent application Ser. No.11/971,358, the entire disclosure of which is hereby expresslyincorporated herein by reference).

Another problem with currently existing compression screws is that theydo not allow for sutures to be attached thereto, thus requiring thatseparate means for attaching sutures, such as suture anchors, be used torepair soft tissue injuries which often accompany a bone fracture. Suchseparate suture anchors require separate insertion locations to beselected and additional insertion holes to be formed into alreadydamaged bone, thereby resulting in prolonged surgical procedure times,increased procedure complexity and costs, and increased patient recoverytime.

BRIEF DESCRIPTION OF THE DRAWINGS

To assist those of ordinary skill in the relevant art in making andusing the inventive concepts disclosed herein, reference is made to theappended drawings and schematics, which are not intended to be drawn toscale, and in which like reference numerals are intended to refer to thesame or similar elements for consistency. For purposes of clarity, notevery component may be labeled in every drawing. Certain features andcertain views of the figures may be shown exaggerated and not to scaleor in schematic in the interest of clarity and conciseness. In thedrawings:

FIG. 1A is a perspective view of an exemplary embodiment of acompression screw system according to the inventive concepts disclosedherein.

FIG. 1B is an enlarged view of circle 1B of FIG. 1A.

FIG. 2A is a perspective view of an exemplary embodiment of a screwdrive according to the inventive concepts disclosed herein.

FIG. 2B is an enlarged view of circle 2B of FIG. 2A.

FIG. 3A is a top perspective view of an exemplary embodiment of acompression screw according to the inventive concepts disclosed herein.

FIG. 3B is a bottom perspective view of the compression screw of FIG.3A.

FIG. 3C is a side elevational view of another embodiment of a lateralprojection of the compression screw of FIG. 3A.

FIG. 3D is a plan view of another embodiment of a lateral projection ofthe compression screw of FIG. 3A.

FIG. 3E is a plan view of another embodiment of a lateral projection ofthe compression screw of FIG. 3A.

FIG. 3F is a side elevational view of another embodiment of a lateralprojection of the compression screw of FIG. 3A.

FIG. 3G is a cross-sectional view of the compression screw of FIG. 3Ashown implanted into a bone.

FIG. 4A is a top perspective view of an exemplary embodiment of acompression screw according to the inventive concepts disclosed hereinshown in combination with a suture coupling.

FIG. 4B is a bottom perspective view of the compression screw of FIG.4A.

FIG. 4C is a cross-sectional view of the compression screw of FIG. 4Ashown implanted into a bone.

FIG. 4D is a top perspective view of the compression screw of FIG. 4A.

FIG. 4E is a bottom perspective view of the compression screw of FIG.4A.

FIG. 5 is a top plan view of an exemplary embodiment of a suturecoupling according to the inventive concepts disclosed herein.

FIG. 6A is a top plan view of another embodiment of a suture coupling.

FIG. 6B is a top plan view of the suture coupling of FIG. 6A withsutures shown integrated therein.

FIG. 6C is a top plan view of the suture coupling of FIG. 6A showingsutures preloaded therein.

FIG. 6D is a top plan view of the suture coupling of FIG. 6A showingsutures preloaded therein.

FIG. 6E is a top plan view of the suture coupling of FIG. 6A showingsuture loops shown integrated therein.

FIG. 7 is a top plan view of another embodiment of a suture coupling.

FIG. 8A is a top plan view of another embodiment of a suture coupling.

FIG. 8B is a top plan view of another embodiment of a suture coupling.

FIG. 9 is a top plan view of another embodiment of a suture coupling.

FIG. 10 is a top plan view of another embodiment of a suture coupling.

FIG. 11A is a top plan view of another embodiment of a suture coupling.

FIG. 11B is a top plan view of another embodiment of a suture coupling.

FIG. 11C is a top plan view of another embodiment of a suture coupling.

FIG. 12 is a top plan view of another embodiment of a suture coupling.

FIG. 13A is a top plan view of another embodiment of a suture coupling.

FIG. 13B is a top plan view of an alternative embodiment of the suturecoupling of FIG. 13A.

FIG. 13C is a top plan view of another embodiment of a suture coupling.

FIG. 13D is a top plan view of another embodiment of a suture coupling.

FIG. 14 is a top plan view of another embodiment of a suture coupling.

FIG. 15 is a cross-sectional view of a coupling clip according to theinventive concepts disclosed herein shown attached to a compressionscrew.

FIG. 16 is a cross-sectional view of a coupling staple according to theinventive concepts disclosed herein.

FIG. 17A is a perspective view of an embodiment of a compression screwaccording to the inventive concepts disclosed herein shown incombination with a suture coupling.

FIG. 17B is a top plan view of the compression screw of FIG. 17A.

FIG. 17C is a side elevational view of the compression screw of FIG.17A.

FIG. 17D is an elevational view of the compression screw of FIG. 17Ashown implanted into a bone.

FIG. 18A is a side elevational view of an exemplary embodiment of acompression screw according to the inventive concepts disclosed hereinshown in combination with a suture coupling.

FIG. 18B is a top plan view of the compression screw of FIG. 18A.

FIG. 18C is a perspective view of the compression screw in combinationwith a suture ring of FIG. 18A with a suture shown pulling on the suturecoupling.

FIG. 18D is a top plan view of the compression screw in combination witha suture ring of FIG. 18A with a suture shown pulling on the suturecoupling

FIG. 19A is a side elevational view of an exemplary embodiment of acompression screw according to the inventive concepts disclosed hereinin combination with a suture coupling.

FIG. 19B is a perspective view of the compression screw of FIG. 19A.

FIG. 20A is a perspective view of an exemplary embodiment of acompression screw according to the inventive concepts disclosed hereinin combination with a suture coupling.

FIG. 20B is a cross-sectional view of the compression screw incombination with a suture coupling of FIG. 20A.

FIG. 21A is a perspective view of an exemplary embodiment of a variableangle compression screw according to the inventive concepts disclosedherein.

FIG. 21B is an enlarged view of circle 21B of FIG. 21A.

FIG. 21C is a cross-sectional view of the variable angle compressionscrew of FIG. 21A.

FIG. 21D is a cross-sectional view of two variable angle compressionsscrews of FIG. 21A shown implanted into a bone.

FIG. 22A is a bottom perspective view of an exemplary embodiment of avariable angle compression screw according to the inventive conceptsdisclosed herein.

FIG. 22B is a top perspective view of the variable angle compressionscrew of FIG. 22A.

FIG. 22C is a cross-sectional view of the variable angle compressionscrew of FIG. 22A.

FIG. 22D is a cross-sectional view of the variable angle compressionscrew of FIG. 22A shown implanted into a bone.

FIG. 23A is a top perspective view of an exemplary embodiment of avariable angle dynamic locking compression screw according to theinventive concepts disclosed herein.

FIG. 23B is a bottom perspective view of the variable angle dynamiclocking compression screw of FIG. 23A.

FIG. 23C is a cross-sectional view of the variable angle compressionscrew of FIG. 23A.

FIG. 23D is a cross-sectional view of the variable angle compressionscrew of FIG. 23A shown implanted into a bone.

FIG. 24 is a cross-sectional view of an exemplary embodiment of a boneplate system according to the inventive concepts disclosed herein shownimplanted into a bone.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

Before explaining at least one embodiment of the inventive concepts indetail, it is to be understood that the inventive concepts disclosedherein are not limited in their application to the details ofconstruction, experiments, exemplary data, and the arrangement of thecomponents set forth in the following description or illustrated in thedrawings. The inventive concepts are capable of other embodiments or ofbeing practiced or carried out in various ways. Also, it is to beunderstood that the phraseology and terminology employed herein is forpurposes of description only and should not be regarded as limiting theinventive concepts disclosed herein in any way.

In the following detailed description of embodiments of the inventiveconcepts, numerous specific details are set forth in order to provide amore thorough understanding of the inventive concepts. However, it willbe apparent to one of ordinary skill in the art that the inventiveconcepts disclosed herein may be practiced without these specificdetails. In other instances, well-known features have not been describedin detail to avoid unnecessarily complicating the instant disclosure.

As used herein, the terms “comprises,” “comprising,” “includes,”“including,” “has,” “having” or any other variation thereof, areintended to cover a non-exclusive inclusion. For example, a process,method, article, or apparatus that comprises a list of elements is notnecessarily limited to only those elements but may include otherelements not expressly listed or inherently present therein.

Unless expressly stated to the contrary, “or” refers to an inclusive orand not to an exclusive or. For example, a condition A or B is satisfiedby anyone of the following: A is true (or present) and B is false (ornot present), A is false (or not present) and B is true (or present),and both A and B are true (or present).

The term “or combinations thereof” as used herein refer to allpermutations and combinations of the listed items preceding the term.For example, “A, B, C, or combinations thereof” is intended to includeat least one of: A, B, C, AB, AC, BC, or ABC, and if order is importantin a particular context, also BA, CA, CB, CBA, BCA, ACB, BAC, or CAB.Continuing with this example, expressly included are combinations thatcontain repeats of one or more item or term, such as BB, AAA, AAB, BBC,AAABCCCC, CBBAAA, CABABB, and so forth. A person of ordinary skill inthe art will understand that typically there is no limit on the numberof items or terms in any combination, unless otherwise apparent from thecontext.

In addition, use of the “a” or “an” are employed to describe elementsand components of the embodiments herein. This is done merely forconvenience and to give a general sense of the inventive concepts. Thisdescription should be read to include one or at least one and thesingular also includes the plural unless it is obvious that it is meantotherwise.

Further, as used herein any reference to “one embodiment” or “anembodiment” means that a particular element, feature, structure, orcharacteristic described in connection with the embodiment is includedin at least one embodiment. The appearances of the phrase “in oneembodiment” in various places in the specification are not necessarilyall referring to the same embodiment, although the instant inventiveconcepts are intended to encompass any and all combinations of thefeatures of the embodiments disclosed herein.

As used herein qualifiers such as “about,” “approximately,” and“substantially” are intended to signify that the item being qualified isnot limited to the exact value specified, but includes some slightvariations or deviations therefrom, caused by measuring error,manufacturing tolerances, stress exerted on various parts, wear andtear, or combinations thereof, for example.

As used herein the terms “guide wire,” “Kirschner wire,” “K-wire,” or“k-wire,” and any variations thereof, include pins or rods used in avariety of medical procedures. K-wires are typically made of stainlesssteel and may be threaded, grooved, or smooth, for example. K-wires havebeen in use since their introduction in 1909, and their structure anduse in medical procedures are deemed to be within the level of ordinaryskill in the art, and as such will not be described herein in detail toavoid unnecessarily complicating the instant disclosure.

The inventive concepts disclosed herein are generally directed to acompression screw having a low-profile head configured to hold one ormore sutures and a drive configured to implant the compression screwinto a bone. Compression screws according to exemplary embodiments ofthe inventive concepts disclosed herein allow surgeons to repairfractured bone, and to reattach torn or detached soft tissues withoutthe use of separate suture anchors.

Referring now to the drawings, and in particular to FIGS. 1A-1B, anexemplary embodiment of a compression screw system 100 is illustrated.The compression screw system 100 includes a screw drive 102 and acompression screw 104. The screw drive 102 and the compression screw 104may be cannulated, such that the compression screw system 100 may beused with a guide wire (not shown), such as a K-wire or another type ofguide wire, for example. It is to be understood, however, that theinstant inventive concepts are not limited to a cannulated screw drive102 and a cannulated compression screw 104, and that in some exemplaryembodiments, a screw drive 102 and a compression screw 104 according tothe inventive concepts disclosed herein may not be cannulated, and may,or may not, be implanted into a bone via a guide wire.

Referring now to FIGS. 2A-2B, the screw drive 102 includes a handle 108and a shaft 110, and may have a central cannula (not shown) extendingtherethrough and configured to allow a guide wire to be passedtherethrough.

The handle 108 is configured to be held by a user, and to allow the userto impart rotational force to the handle 108. The handle 108 is made ofany suitable material such as plastic, metals, ceramics, resins,rubbers, or combinations thereof, for example. The handle 108 has aproximal end 112, and a distal end 114 including a suture fixationcollar 116 having one or more suture fixation notches 118 formedtherein. The suture fixation collar 116 and the suture fixation notches118 may cooperate to retain one or more sutures therein and help holdsuch sutures in place during a surgical procedure, for example.

The handle 108 may further include grip-enhancing features or surfaces(not shown), such as grooves, striations, bumps, knurls, crimps, ridges,rubberized inlays or inserts, or combinations thereof, for example.Further, the handle 108 may have visual markings (not shown) enabling auser to visually count the number of turns the handle 108 has completed,in order to estimate the depth and position of a compression screw 104during implantation procedures, for example.

The shaft 110 includes a proximal end 120 fixedly connected to thehandle 108, and a distal end 122 provided with a drive 124. The shaft110 may be made of any suitable material having sufficient strength anddurability, such as stainless steel, titanium, resins, plastics, metals,ceramics, or combinations thereof, for example.

The drive 124 has projections 126 separated by recesses 128. Therecesses 128 are configured to receive corresponding projections of thehead of the compression screw 104 therein, such that rotational forcemay be transferred from the screw drive 102 to the compression screw 104as will be described herein below, for example. While four projections126 are shown in FIGS. 1-2, it is to be understood that the inventiveconcepts disclosed herein may include any number of longitudinalprojections 126, such as two, three, five, or more than fivelongitudinal projections 126, for example.

Referring now to FIGS. 3A-3B, the compression screw 104 includes a head130 and a shaft 132 fixedly attached to the head 130. The compressionscrew 104 may be made of any suitable bio-inert, biocompatible, orbio-absorbable material, such as stainless steel, titanium,polyethylene, poly-lactic-acid (PLA), poly lactic co-glycolic acid(PLGA), polyurethane, bone tissue, ultra-high molecular weightpolyethylene fibers, epoxy resins, or combinations thereof, for example.The compression screw 104 may be formed using any suitable process, suchas molding, machining, casting, or combinations thereof, for example.

The head 130 is illustrated in FIGS. 3A and 3B as having a generallycloverleaf shape with a plurality of projections 134 extending radiallyoutwardly and configured to at least partially fit into the recesses 128and interlock with correspondingly shaped projections 126 of the drive124 such that rotational force and rotational motion may be imparted tothe compression screw 104 by the screw drive 102. The head 130 isdesirably of low profile such that when the compression screw 104 isimplanted into a bone the head 130 is substantially level with thesurface of the bone to minimize soft tissue irritation and injury as aresult of the head 130 interacting with adjacent soft tissues. As usedherein substantially level is intended to include the head 130 beinglevel with the surface of the bone, and protruding slightly over thesurface of the bone, but such slight protrusion is kept as low aspossible to avoid irritating or damaging adjacent soft tissues, forexample.

The head 130 is shown as having four projections 134 with each of theprojections 134 having a suture fixation hole 136 formed therein. It isto be understood, however, that the head 130 may be formed to have avariety of configurations and number of projections. For example, thehead 130 may be formed to have projections numbering two, three, or morethan four. The suture fixation holes 136 may be formed into theprojections 134 in any suitable manner, such as injection molding,drilling, or combinations thereof, for example. The suture fixationholes 136 function to allow for one or more sutures to be passedtherethrough so that a soft tissue may be attached to the head 130. Itis to be understood that while four suture fixation holes 136 are shownin FIGS. 3A-3B, the inventive concepts disclosed herein may beimplemented with suture fixation holes 136 omitted as will be describedbelow, or with any number of suture fixation holes 136. Further, while asuture fixation hole 136 is shown on each projection 134, it is to beunderstood that some projections 134 may have no suture fixation holes136 formed therein, and some projections 134 may have one or more suturefixation holes 136 formed therein. It is to be further understood thatin some embodiments, suture fixation holes 136 may be implemented as oneor more grooves (FIG. 3C), one or more channels (FIG. 3D), one or moreresilient jaws (FIGS. 3E and 3F), one or more hooks, one or more grooveson the surface of the head 130 engaging the bone, one or more channelsor grooves into the side of the head 130 engaging the bone, orcombinations thereof, for example. Further, in some exemplaryembodiments a suture may be wound around the shaft 132 and theprojections 134 may be used to compress, catch, trap, or otherwiseretain the suture in place.

The shaft 132 has a proximal end 138 fixedly attached to the head 130and a distal end 140 having threads 142 formed on an external surfacethereof. The threads 142 are configured to engage bone tissue such thatthe compression screw 104 is screwed into the bone and retained thereinwhen rotational motion is applied to the compression screw 104 by thescrew drive 102 relative to the longitudinal axis 148. It is to beunderstood, that a compression screw 104 according to the inventiveconcepts disclosed herein may be implanted into any type of bone ortissue, and may have threads 142 configured to engage cortical bonetissue, cancellous bone tissue, cartilage, connective tissue, orcombinations thereof, for example.

The shaft 132 is shown as having an unthreaded portion 144, but it is tobe understood that some exemplary embodiments of the compression screw104 may omit the unthreaded portion 144 and may include threads 142extending along the length of the shaft 132. Further, some exemplaryembodiments may include other retention means or features (not shown)such as ribs, grooves, bumps, channel, protrusions, or combinationsthereof, instead of, or in addition to, the threads 142. The threads 142may be self-tapping or self-drilling, or a drill or other tool may beused to form a suitable size opening or channel into the bone for thethreads 142 to engage, for example.

The compression screw 104 has a central cannula 146 extending throughthe shaft 132 and the head 130, and a longitudinal axis 148. The centralcannula 146 is configured to receive a guide wire during theimplantation of the compression screw 104 into a patient's bone. It isto be understood, however, that a compression screw 104 according to theinstant inventive concepts may omit the central cannula 146 in someexemplary embodiments, and such uncannulated compression screw 104 maybe implanted with, or without, the use of a guide wire.

Referring now to FIG. 3G, in use the compression screw 104 is implantedinto a bone 150 such that the threads 142 engage a cancellous portion152 of the bone 150, and the head 130 is compressed against a surface ofa cortical portion 154 of the bone 150. The shaft 132 may be advancedinto the bone 150 so that a desired compressive force is applied to thebone 150, for example. The head 130 is shown as being oriented relativeto the longitudinal axis 148 of the shaft 132 at an angle α. It is to beunderstood that the angle α may include any angle, including an angle of90° and some slight deviations from an angle of 90°, such as deviationsdue to manufacturing tolerances, and deformation in the compressionscrew 104 caused by compressive forces exerted on the head 130 by thebone 150 when the compression screw 104 is implanted into the bone 150,or combinations thereof, for example. One or more sutures 151 may bethreaded through a suture fixation hole 136, for example, so that theone or more sutures 151 are held by the compression screw 104. A softtissue may be anchored to the bone 150 via the one or more sutures 151.

Referring now to FIGS. 4A-4C, shown therein is an exemplary embodimentof a compression screw 104 a, which may be implemented similarly tocompression screw 104, except that the suture fixation holes 136 areomitted. The compression screw 104 a includes a head 160 and a shaft 162having a longitudinal axis 164. The compression screw 104 a may be madeof any suitable bio-inert or bio-absorbable material, such as stainlesssteel, titanium, polyethylene, poly-lactic-acid (PLA), poly lacticco-glycolic acid (PLGA), polyurethane, human bone tissue, ultra-highmolecular weight polyethylene fibers, epoxy resins, or combinationsthereof, for example. The compression screw 104 a may be formed usingany conventional process, such as molding, machining, casting, orcombinations thereof, for example.

The head 160 is shown as a generally cloverleaf shaped structurecomprising a plurality of projections 166 configured to interlock withcorrespondingly shaped longitudinal projections 126 of the screw drive102 (e.g., by being at least partially positioned into recesses 128),such that rotational motion may be imparted to the compression screw 104a by the screw drive 102. The head 160 is desirably of low profile, suchthat when the compression screw 104 a is implanted into a bone, the head160 is substantially level with the surface of the bone, to minimizeadjacent soft tissue irritation and injury as a result of the head 160interacting with adjacent soft tissues. As used herein substantiallylevel includes the head 160 protruding slightly over the surface of thebone, but such slight protrusion is kept as low as possible to avoidirritating or damaging adjacent soft tissues, for example.

The shaft 162 has a proximal end 168 fixedly attached to the head 160,and a distal end 170 having threads 172 formed on an external surfacethereof. The threads 172 are configured to engage a bone (e.g., corticalor cancellous bone tissue) such that the compression screw 104 a isscrewed into the bone tissue and retained therein when rotational motionis applied to the compression screw 104 a by the screw drive 102. Theshaft 162 is shown as comprising an unthreaded portion 174, but it is tobe understood that some exemplary embodiments of the compression screw104 a may omit the unthreaded portion 174 and may include threads 172along the length of the shaft 162. Further, some exemplary embodimentsmay include other retention means or features (not shown), such as ribs,grooves, bumps, channels, protrusions, or combinations thereof, insteadof, or in addition to, the threads 172. The threads 172 may beself-tapping or self-drilling, or a drill or other tool may be used toform a suitable size opening or channel into the bone for the threads172 to engage, for example.

The compression screw 104 a has a central cannula 176 extending throughthe shaft 162 and through the head 160. The central cannula 176 isconfigured to receive a guide wire, such as a K-wire, for example,during the implantation of the compression screw 104 a into a patient'sbone. It is to be understood however, that a compression screw 104 aaccording to the instant inventive concepts may omit the central cannula176 in some exemplary embodiments, and such non-cannulated compressionscrew 104 a may or may not be implanted without the use of a guide wire106.

Referring to FIGS. 4A-4C and 5, a suture coupling 178 may be used incombination with the compression screw 104 a to treat or repair softtissue injuries. The suture coupling 178 includes a thin, flat body 179having an opening 180 configured to receive the shaft 162 of thecompression screw 104 a, such that the suture coupling 178 is compressedbetween the head 160 of the compression screw 104 a and the surface of abone when the compression screw 104 a is implanted into the bone. Insome embodiments, the suture coupling 178 may be sized such that it fitssnugly around the unthreaded portion 174 of the shaft 162, to keep thesuture coupling 178 substantially centered relative to the shaft 162. Inother embodiments, the suture coupling 178 may be sized to be interposedbetween a suture anchor (not shown) and a surface of the bone.

The suture coupling 178 is desirably made of a soft or pliable bio-inertmaterial, such as a textile material (e.g., any cloth, or goods producedby weaving, knitting, braiding, twisting, or felting, of one or morefibers or other materials), a foam material, polyethylene, polyurethane,PLA, PLGA, Ultra High Molecular Weight Polyethylene fibers, andcombinations thereof, for example. A soft or pliable material wouldallow the suture coupling 178 to conform to the shape of the surface ofthe bone, and to have no sharp edges, thereby minimizing soft tissueirritation. Further, the suture coupling 178 may be folded and insertedthought the cannula of an arthroscopic surgical instrument such as thescrew drive 102, for example. The suture coupling 178 may be used toattach one or more sutures 182 (FIG. 4C) to the compression screw 104 a,such as by tying one or more sutures 182 to the suture coupling 178, orby sewing one or more sutures 182 into the suture coupling 178, orcombinations thereof, for example. The suture coupling 178 may be coatedor impregnated with a variety of substances, including but not limitedto antibiotics, healing agents, anti-clotting agents, anti-inflammatoryagents, or combinations thereof, for example.

The head 160 is shown as being oriented relative to the longitudinalaxis 164 of the shaft 162 at an angle α. It is to be understood that theangle α may include any angle, including an angle of 90° and some slightdeviations from an angle of 90°, such as deviations due to manufacturingtolerances, and deformation in the compression screw 104 a caused bycompressive forces exerted on the head 160 by a bone 184 when thecompression screw 104 a is implanted into a bone 184, or combinationsthereof, for example.

As will be appreciated by persons of ordinary skill in the art, the useof a compression screw 104 a with the suture coupling 178 allows forusing a suture first technique (e.g., one or more sutures 182 areattached to the suture coupling 178 prior to the inserting the suturecoupling 178 on the compression screw 104 a and implanting thecompression screw 104 a), or an implant first technique (e.g., thesuture coupling 178 is inserted on the compression screw 104 a, thecompression screw 104 a is implanted into the bone 184, and then one ormore sutures 182 are secured to the suture coupling 178). As will beunderstood by persons of ordinary skill in the art, a portion of thesuture coupling 178 extending between two projections 166 may remainaccessible to a user after the compression screw 104 a is implanted intothe bone 184. The compression crew 104 a may be advanced into the bone184 so that a desired compressive force is applied to the bone 184, forexample.

Referring now to FIGS. 4D-4E, shown therein is the compression screw 104a with a suture coupling 186 inserted thereon. The suture coupling 186can be implemented similarly to the suture coupling 178, except that thesuture coupling 186 has a body 187 with a substantially rounded surface,whereas the body of the suture coupling 178 is substantially flat.Further, the suture coupling 186 may be constructed of a relativelystiffer material than the suture coupling 178, such as reinforcedrubber, stainless steel, nitinol, titanium, Cobalt Chromium, a tightlywoven textile, and combinations thereof, for example. The roundedsurface of the suture coupling 186 may further minimize adjacent softtissue irritation and damage, and may result in increased strength ofthe suture coupling 186 as compared with a suture coupling 178constructed of the same, or similar material, for example.

Referring now to FIG. 6A, shown therein is an exemplary embodiment ofanother suture coupling 190. The suture coupling 190 is similar to thesuture coupling 178 with the exception that the suture coupling 190includes a reinforced inner edge 196 and a reinforced outer edge 198.The reinforced inner edge 196 and the reinforced outer edge 198 may beimplemented by braiding or weaving a second layer of materialinterlinked with the coupling base during the manufacture of the suturecoupling 190, for example, or in any other suitable manner.

FIG. 6B shows the suture coupling 190 with sutures 200 that are sewn toor otherwise integrated with the suture coupling 190. The sutures 200may be used to attach a soft tissue to the suture coupling 190, such asby, for example, threading one or more suture 200 through the tissue tobe attached, tying off the sutures 200, and clipping, cutting, orotherwise removing any excess portion of the sutures 200.

FIG. 6C shows the suture coupling 190 with sutures 202 preloaded thereinso as to facilitate the use of sliding knots, for example.

FIG. 6D shows the suture coupling 190 with sutures 203 preloadedtherein. The sutures 203 are provided with needles 204. Needles 204 areshown attached to each suture 203 and may be used for attaching thesutures 203 to soft tissue, for example.

FIG. 6E shows the suture coupling 190 with suture loops 206 sewn to orotherwise integrated with the suture coupling 190. The suture loops 206are configured to allow for a soft tissue to be attached to the suturecoupling 190, as will be understood by persons of ordinary skill in theart.

Referring now to FIG. 7, shown therein is an exemplary embodiment ofanother suture coupling 208. The suture coupling 208 is similar to thesuture coupling 190 except the suture coupling 208 includes a reinforcedouter edge 212 and a reinforced inner edge 214. The reinforced outeredge 212 has a rigid reinforcing ring 218 and the reinforced inner edge214 has a rigid reinforcing ring 220. The reinforcing rings 218 and 220may be in the form of a rigid wire, and may be constructed of a metal orpolymer, or of any other suitable material. The rigid reinforcing rings218 and 220 may be implemented during the manufacture of the suturecoupling 208, such as, for example, by interlinking the reinforcingrings 218 and 220 with the suture coupling 208, or by weaving the suturecoupling 208 around the reinforcing rings 218 and 220, for example.

Referring now to FIG. 8A, shown therein is an exemplary embodiment ofyet another suture coupling 222. The suture coupling 222 is similar tothe suture coupling 190 except the suture coupling 222 is provided withan opening 230 and with one or more suture eyelets 232. The sutureeyelets 232 may be defined by a reinforced edge 234 such that a suturemay be threaded therethrough. The suture eyelets 232 are configured toallow one or more sutures to be threaded therethrough, but it is to beunderstood that the sutures may also be sewn into, or threaded through,the suture coupling 222, or passed through the opening 230, orcombinations thereof, for example.

FIG. 8B illustrates a suture coupling 222 a which is similar to thesuture coupling 222 except that the suture coupling 222 a is providedwith a plurality of reinforcement segments 231. The reinforcementsegments 231 may extend radially from an opening 230 a to the outer edgeso as to define a plurality of suture sections 231 a. The suturecoupling 222 a is shown to have four reinforcement segments 231, but itwill be appreciated that the number of reinforcement segments may bevaried.

Referring now to FIG. 9, shown therein is an exemplary embodiment of asuture coupling 236. The suture coupling 236 is similar to the suturecoupling 190 except the suture coupling 236 is shown as having an ovalshape and a pair of openings 242 a and 242 b for receiving a pair ofscrews therein. One or more sutures may be threaded through the suturecoupling 236, the opening 242 a, or the opening 242 b. While the suturecoupling 236 has been illustrated as being oval shaped and as having twoopenings 242 a and 242 b, it should be appreciated that the suturecoupling 236 may be constructed in a variety of shapes and with morethan two openings 242 a and/or 242 b, for example.

Referring now to FIG. 10, shown therein is an exemplary embodiment of asuture coupling 246. The suture coupling 246 is similar to the suturecoupling 190 except the suture coupling 246 is shown to be substantiallycross-shaped so as to include a plurality of projections 248 and 249.The projections 248 are illustrated as having a length greater than thelength of the projections 249 to permit the projections 248 to bewrapped around the head of a compression screw, such as the compressionscrew 104 or 104 a, for example. Once wrapped around the head (e.g., thehead 130 or the head 160 of a compression screw 104 or 104 a), theprojections 248 may be stitched or otherwise attached to one another tosecure the suture coupling 246 around the head of the compression screwand thereby minimize irritation to adjacent soft tissues.

Referring now to FIG. 11A, shown therein is another embodiment of asuture coupling 254. The suture coupling 254 is similar to the suturecoupling 190 except the suture coupling 254 is provided with a slit 264extending from the outer edge to the inner edge. The slit 264 allows thesuture coupling 254 to be positioned about a screw 104 or 104 a afterthe screw 104 or 104 a has been inserted at least partially into bone.The outer edge has two or more closure loops 266 that permit a suture(not shown) to be threaded through the closure loops 266 and tightenedto close the suture coupling 254 once positioned about the screw 104 or104 a, for example.

FIG. 11B shows another suture coupling 254 a which is similar to thesuture coupling 254 except that the suture coupling 254 a is providedwith a plurality of reinforcement segments 231 a. The reinforcementsegments 231 a may extend radially from an opening 230 b to the outeredge so as to define a plurality of suture sections 231 b. The suturecoupling 254 a is shown to have four reinforcement segments 231 a, butit will be appreciated that the number of reinforcement segments may bevaried. The suture coupling 254 a is further shown to include aplurality of suture eyelets 255.

FIG. 11C illustrates a suture coupling 254 b. The suture coupling 254 bis similar to the suture coupling 254 a except that the suture coupling254 b is provided with a plurality of projections 258. The projections258 may be provided with a length sufficient to extend a distance fromone or more edges of a bone plate, such as bone plate 482 shown in FIG.24, when the suture coupling is secured between the bone plate and abone. The suture coupling 254 a may be provided with an opening 259 forreceiving a screw and a slit 254 a extending from the opening 259 to theouter edge. The projections 258 may further be provided with one or moresuture eyelets 260.

Referring now to FIG. 12, shown therein is an exemplary embodiment of asuture coupling 270. The suture coupling 270 is similar to the suturecoupling 190 except the suture coupling 270 is provided with areinforcement mesh 286 on at least one side of the body of the suturecoupling 270. The reinforcement mesh 286 may resemble a spider web andmay be fabricated of a rigid metal, polymer, or any other suitablematerial. The reinforcement mesh 286 functions to provide rigidity andto minimize tissue liftoff during use of the suture coupling 270.

Referring now to FIG. 13A, shown therein is an exemplary embodiment of asuture coupling 290. The suture coupling 290 is flower-shaped so as tobe provided with a plurality of petals or protrusions 294. The flowershaped suture coupling 290 may be constructed by using standard weavingtechniques, for example, and may have its edges reinforced, such as bybraiding or weaving a second layer of material interlinked with thecoupling base during the manufacture of the suture coupling 290. Theprotrusions 294 are provided with suture eyelets 298 which may beimplemented and function similarly to the suture eyelets 232, forexample.

Referring now to FIG. 13B, shown therein is another embodiment of asuture coupling 290 a. The suture coupling 290 a is similar to thesuture coupling 290 except the suture coupling 290 a is formed of awool-like textile. It should be understood that the term wool-liketextile as used herein is intended to include a relatively softer andless dense textile material as compared with the suture coupling 290.The wool-like textile may be fabricated, for example, from one or acombination of materials including non-resorbable polymers such aspolyethylene, polypropylene, ultra high molecular weight polyethylene,Poly-ether-ether-ketone (PEEK), Poly-ether-ketone-ketone (PEKK),resorbable polymers, such as poly-lactic acid (PLA), poly-L-lactide(PLLA), poly-L/D-lactide (PLDLA), poly-lactic-co-glycolic acid (PLGA),Poly-glycolide or Poly-glycolic acid (PGA), Poly-capro-lactone (PCL), orsoft metals, such as nitinol. The suture coupling 290 a may have itsedges and suture eyelets reinforced, such as by braiding or weaving asecond layer of material interlinked with the coupling base during themanufacture of the suture coupling 290, for example.

Referring now to FIG. 13C, shown therein is another embodiment of asuture coupling 290 b. The suture coupling 290 b is similar to thesuture coupling 290 except the suture coupling 290 ba is configured tohave a generally clover shape so as to be provided with a plurality ofpetals or protrusions 294 b. The protrusions 294 b are provided withsuture eyelets 298 b which may be implemented and function similarly tothe suture eyelets 232, for example.

FIG. 13D shows a suture coupling 290 c which is generally cam shaped orwedge shaped. As such, the suture coupling 290 c has a narrow end 299 aand a wide or flared end 299 b. The narrow end 299 a is provided with anopening 300 a for receiving a shaft of a compression screw. The wide end299 b may be provided with suture eyelets 300 b.

Referring now to FIG. 14, shown therein is an exemplary embodiment of asuture coupling 304. The suture coupling 304 is similar to the suturecoupling 190 except the suture coupling 304 is not initially providedwith an opening. As such, a user may cut or otherwise form a hole forreceiving an implant, such as a compression screw or anchor wheredesired in the suture coupling 304, for example.

Referring now to FIG. 15, shown therein is a coupling cap 310 accordingto the inventive concepts disclosed herein. The coupling cap 310 may beinserted, clipped-on, or otherwise attached to a head of a surgicalscrew (e.g., 104 or 104 a), such that the coupling cap 310 prevents asuture coupling 318 from lifting, or being lifted, away from a bone 316.For example, the coupling cap 310 may be affixed inside a screw drive312 of a surgical screw 314, after the surgical screw 314 is implantedinto a bone 316 such that a peripheral edge 317 of the coupling cap 310is positioned adjacent to or in contact with at least one of the suturecoupling 318 or a suture 319 attached to and extending from the suturecoupling 318. It is to be understood that the coupling cap 310 may beused with any of the suture couplings disclosed herein, and may be usedwith prior art suture couplings in some exemplary embodiments.

Referring now to FIG. 16, shown therein is an exemplary embodiment of acoupling staple 320 according to the inventive concepts disclosedherein. One or more coupling staples 320 may be used in combination withany of the suture couplings disclosed herein, and may function toprevent suture coupling rotation and lift-off, for example. The couplingstaple 320 may be implanted into a bone 316 after a suture coupling 318having a suture 319 attached thereto is already implanted via a surgicalscrew 314, of may be pre-assembled with the suture coupling 318,depending on the surgical procedure needs, or surgeon preference, forexample. The coupling staple 320 may be constructed of any suitablematerial, such as metals, metal polymers, plastics, ceramics, resins,polymers, or combinations thereof, for example. The coupling staple 320may be inserted through the suture coupling 318 and into the bone 316,such as by driving the coupling staple 320 into the bone 316 via asuitable surgical tool (not shown), for example.

Referring now to FIGS. 17A-17C, shown therein is the compression screw104 with a suture ring 186 inserted thereon. A suture 322 is shownthreaded through the suture ring 186 and pulling the suture ring 186slightly away from the shaft 144 of the compression screw 104. As can beseen in FIG. 17D, the suture ring 186 is compressed between thecompression screw 104 and a bone 324, preventing the suture 322 frompulling the suture ring 186 away from the compression screw 104.

Referring now to FIGS. 18A-18D, shown therein is an embodiment of acompression screw 326 with a suture ring 186 inserted thereon accordingto the inventive concepts disclosed herein. The compression screw 326may be implemented similarly to the compression screw 104, except thatthe projections 328 are longer than the projections 134 of thecompression screw 104, for example. This allows the suture ring 186 toremain attached to the compression screw 326 as a suture 329 is pullingthe suture ring 186 away from the compression screw 326.

Referring now to FIGS. 19A-19B, shown therein is an embodiment of acompression screw 330 according to the inventive concepts disclosedherein. The compression screw 330 may be implemented similarly to thecompression screw 104 a, and has one or more teeth 332 formed in a boneengaging surface 333 of a head 334. The teeth 332 function to engage asuture ring 186 (e.g., by compressing the suture ring 186 against abone) and prevent the suture ring 186 from being pulled away from thehead 334. It is to be understood, however, that a compression screw 330may be used in combination with any of the suture couplings and suturerings described herein, as well as with any conventional suturecouplings, as will become apparent to a person of ordinary skill in theart having the benefit of the instant disclosure.

Referring now to FIGS. 20A-20B, shown therein is an embodiment of acompression screw 336, shown in combination with a suture ring 186. Thecompression screw 336 may be implemented similarly to the compressionscrew 104 a, except that the compression screw 336 has an annular groove338 formed in a bone engaging surface 340 of a head 342 thereof. Theannular groove 338 is sized such that it may house at least a portion ofthe suture ring 186 therein, such that the suture ring 186 is compressedbetween the surface 340 and a bone, and is prevented from being pulledaway from the compression screw 336 by one or more sutures. It is to beunderstood that a cylindrical annular groove (not shown) may be formedin the bone engaging surface 340 in some exemplary embodimentsconfigured to house a suture coupling constructed according to theinventive concepts disclosed herein.

Referring now to FIGS. 21A-21D, shown therein is an exemplary embodimentof a variable angle compression screw 350 according to the instantinventive concept. The variable angle compression screw 350 has a head352 in combination with a shaft 354 having a longitudinal axis 356, aproximal end 358, and a distal end 360.

The shaft 354 includes a central cannula 362 extending therethrough. Thecentral cannula 362 is configured to allow for the insertion of a guidewire (not shown), such as a K-wire, for example. It is to be understood,however, that some exemplary embodiments of the variable anglecompression screw 350 according to the instant inventive concepts mayomit the central cannula 362 and may, or may not, be implanted into abone over a guide wire.

The proximal end 358 of the shaft 354 includes a convex portion 364having threads 366 formed thereon. The threads 366 are desirablyoriented radially relative to the longitudinal axis 356 of the shaft354. The threads 366 may be any suitable threads 366 having any suitablepitch, and may be formed into the convex portion 364 in any suitablemanner, such as molding, cutting, machining, or combinations thereof,for example.

The proximal end 358 further has a hexagonal drive 368 (FIGS. 21C-21D),which is configured to receive the head of a conventional hexagonaldriver (not shown) such that rotational motion may be imparted to theshaft 354 relative to the longitudinal axis 356. It is to be understood,however, that the proximal end 358 may include a drive configured toengage any conventional drive instead of a hexagonal drive 368 in someexemplary embodiments of the instant inventive concepts, such asPhillips drive, flat drive, cross drive, octagonal drive, andstar-shaped drive, for example.

The distal end 360 of the shaft 354 has threads 370 formed therein, thethreads 370 configured to engage a bone, such that the variable anglecompression screw 350 may be implanted into the bone and retainedtherein. The shaft 354 is shown as comprising an unthreaded portion 372,but it is to be understood that some exemplary embodiments of a variableangle compression screw 350 may omit the unthreaded portion 372 and mayhave threads 370 along the length of the shaft 354. Further, someexemplary embodiments of a shaft 354 may include other retention meansor features (not shown) such as ribs, grooves, bumps, channels,protrusions, or combinations thereof, instead of, or in addition to, thethreads 370. The threads 370 may be self-tapping or self-drilling, or adrill may be used to pre-drill a suitable size opening or channel intothe bone at any desired angle for the threads 370 to engage, forexample.

The head 352 is shown as being a cloverleaf shaped structure with aplurality of projections 374 each with a suture fixation hole 376 formedtherein. The head 352 further includes a central opening 378 havingcolumns of threads 380 formed in an internal surface thereof. Thecentral opening 378 is configured to threadingly receive the convexportion 364 of the shaft 354 therein, such that the threads 380 engagewith the threads 366 of the shaft 354 to secure the head 352 to theshaft 354 at any desired angle. It is to be understood that while fourcolumns of threads 380 are shown in FIG. 21C, the instant inventiveconcepts may be used with continuous threads 380, for example, or withless than four, or more than four columns of threads 380.

An exemplary embodiment of using the variable angle compression screw350 includes forming an opening into a bone 382. The shaft 354 of avariable angle compression screw 350 may then be advanced into theopening such as by applying rotational motion to the shaft 354 with adriver (not shown) relative to the longitudinal axis 356. Once theproximal end 358 of the shaft 354 is level with the surface of the bone382, or is just below the surface of the bone 382, the head 352 may beheld against the surface of the bone 382 (e.g., via the screw drive102), such that the central opening 378 is aligned with the opening inthe bone 382. In one exemplary embodiment, the shaft 354 may be backedout of the bone 382 such that the threads 366 engage with the threads380 to securely attach the head 352 to the shaft 354. In anotherexemplary embodiment, the head 352 may be screwed onto the shaft 354. Aswill be understood by a person of ordinary skill in the art having thebenefit of the instant disclosure, when the head 352 is connected to theshaft 354, the head 352 may have a varying angle α relative to thelongitudinal axis 356 of the shaft 354, and such angle α may range in apredetermined range between about 90° and about 135°, or between about90° and about 120° in either direction from the longitudinal axis 356,including any ranges and sub-ranges therebetween, for example.

Further, one or more sutures (not shown) may be secured to the head 352via a suture fixation hole 376 prior to securing the head 352 to theshaft 354, for example. It is to be understood that in some exemplaryembodiments, suture fixation holes 376 may be omitted, and/or a suturecoupling may be used to secure one or more sutures to the variable anglecompression screw 350 by positioning such suture coupling between thehead 352 and the bone 382, and using the shaft 354 to secure the head352 and suture coupling to the bone 382 as described above, for example.Further, in some embodiments a suture fixation hole 376 may be used tosecure one or more sutures to the head 352 and one or more suturecouplings may be used to secure one or more sutures to the head 352, orcombinations thereof, for example.

Referring now to FIGS. 22A-22D, shown therein is an exemplary embodimentof a compression screw 384 according to the inventive concepts disclosedherein. The compression screw 384 includes a shaft 386 having alongitudinal axis 388 and a head 390.

The shaft 386 has a proximal end 392 and a distal end 394 and a centralcannula 396 extending therethrough. The proximal end 392 includes a neckportion 398 and a concave collar 400 having threads 402 formed on theconcave surface thereof. The proximal end 392 further includes a hexdrive 404 configured to receive a hex driver (not shown) such thatrotational motion may be imparted onto the shaft 386 relative to thelongitudinal axis 388. The distal end 394 has threads 406 formedtherein, the threads 406 configured to engage a bone. It is to beunderstood that while the shaft 386 is shown as comprising an unthreadedportion 408, the shaft 386 may include threads 406 along its entirelength in some embodiments of the inventive concepts disclosed herein.Further, it is to be understood that some exemplary embodiments may omitthe hex drive 404, and may have any conventional screw drive capable ofimparting rotational force, or motion, to the shaft 386.

The head 390 has an opening 410 and one or more projections 412. Theopening 410 is sized so that the head 390 is slidably positioned aboutthe neck portion 398 of the shaft 386, and so that the head 390 mayslide along the neck portion 398 of the shaft 386. It is to beunderstood that while the head 390 is shown as comprising a clover-leafshape having four projections 412, any suitable shape head 390 may beused with the inventive concepts disclosed herein, such as a three-leafclover shaped head 390, a circular head 390, and a square head 390, forexample. In some exemplary embodiments, the outer edges of the head 390may taper down, such that the head 390 has a convex shaped cross-sectionrather than a rectangular cross section, in order to reduce soft tissueirritation/injury.

The one or more projections 412 may include suture fixation holes 414configured to secure one or more sutures (not shown) therein.

The opening 410 tapers inwardly from the proximal end 392 towards thedistal end 394 of the shaft 386, and includes four columns of threads416 configured to engage the threads 402 on the concave collar 400. Aswill be understood by persons of ordinary skill in the art, sucharrangement of the threads 416 and 402 allows the concave collar 400 toengage the opening 410 of the head 390 so that the head 390 is orientedat an angle α relative to the longitudinal axis 388, which angle α mayvary from about 90° to about 120°, including any ranges and sub-rangestherebetween, for example. This allows for the compression screw 384 tohave a variable angle between the head 390 and the shaft 386, such thatthe head 390 sits as level as possible with the surface of a bone 418when the compression screw 384 is implanted into the bone 418.

The compression screw 384 may be made by any suitable process, such asinjection molding, machining, casting, or combinations thereof, forexample. In a non-limiting embodiment, the shaft 386 may include a firstportion 420 and a second portion 422 slidably received in the firstportion 420 and welded, glued, or otherwise secured therein. To assemblethe compression screw 384, the head 390 is slid onto the neck portion398 of the second portion 422, and the second portion 422 is slid intothe first portion 420, and secured therein as described above. For anexample of such two-portion compression screw see U.S. patentapplication Ser. No. 12/332,756, the entire contents of which are herebyincorporated herein by reference. It is to be understood, however thatthe compression screw 384 may have a shaft 386, and the head 390 mayhave two portions joined to one another such that the head 390 isslidably positioned onto the neck portion 398 of the shaft 386, forexample.

In operation, the shaft 386 is gradually advanced into the bone 418,such as by imparting rotational motion to the shaft 386 via a hex driver(not shown) engaging the hex drive 404, for example. The compressionscrew 384 may or may not be implanted over a guide wire (not shown)inserted through the central cannula 396 (FIG. 22C) extending throughthe shaft 386, for example. Just as the neck portion 398 begins toadvance under the surface of the bone 418, the threads 416 of the head390 are engaged by the threads 402 of the concave collar 400, at anangle α reflecting the angle of the surface of the bone 418 with whichthe head 390 is in contact as shown in FIG. 22C. The compression screw384 may be advanced further, until a desired compressive force isapplied to the bone 418 by the head 390, for example.

Referring now to FIGS. 23A-23D shown therein is an exemplary embodimentof a variable-angle dynamic locking screw (DLS) 430 according to theinstant inventive concepts. The variable angle DLS 430 includes a shaft432, a longitudinal axis 434, and a head 436.

The shaft 432 has a cannula 438 extending therethrough and a proximalend 440 and a distal end 442. The proximal end 440 includes an outerwall 444, and an inner wall 446 spaced apart at a distance, such that anannular space 448 is defined by the outer wall 444 and the inner wall446. The annular space 448 functions to allow the inner wall 446 to movetowards and away from the outer wall 444 in a radial direction relativeto the longitudinal axis 434.

The shaft 432 has a first portion 450 having an open end defining acylindrical space and a second portion 452 configured to be slidablyreceived in the cylindrical space and secured therein, such that theannular space 448 is defined by the first portion 450 and the secondportion 452. The first portion 450 and the second portion 452 may besecured to one another in any suitable manner, such as welding,ultrasonic welding, adhesives, or combinations thereof, for example. Foran exemplary method of making a dynamic locking screw see U.S. patentapplication Ser. Nos. 12/332,756, and 12/940,531 the entire contents ofwhich are hereby incorporated herein by reference.

The proximal end 440 further includes a neck portion 454 and a collar456 extending above the first portion 450 of the shaft 432. The collar456 is substantially concave and tapers inwardly relative to thelongitudinal axis 434 from the proximal end 440 towards the distal end442. The collar 456 has threads 458 on the concave surface 460 thereof.The collar 456 further has a hex drive 462 configured to accept a hexdriver (not shown) such that rotational motion may be imparted on theshaft 432 via the hex drive 462 relative to the longitudinal axis 434.

The distal end 442 includes threads 464 configured to engage acancellous portion 466 of a bone tissue 468, such that the shaft 432 maybe retained therein.

The head 436 is slidably disposed about the neck portion 454 andincludes a central opening 470 which tapers inward towards thelongitudinal axis 434 from the proximal end 440 towards the distal end442. The head 436 may be disposed about the neck portion 454 prior tojoining the first portion 450 and the second portion 452 of the shaft432, for example.

The central opening 470 further has four rows of threads 472 configuredto engage the threads 458 of the collar 456. The threads 472 engage thethreads 458 such that the head 436 is oriented relative to thelongitudinal axis 434 at an angle α, which angle α may vary from about90° to about 130°, including any ranges and sub-ranges therebetween, forexample.

The head 436 further has one or more projections 474 having suturefixation holes 476 formed therein. The suture fixation holes 476 areconfigured to secure one or more sutures (not shown), such as bycompressing one or more sutures between the head 436 and the bone 468,for example.

In operation, the shaft 432 is advanced into the bone 468 at anysuitable angle as described above. The shaft 432 may be advanced viaself-tapping or self-drilling threads 464, or a suitable size channel oropening may be formed into the bone 468, into which the shaft 432 isadvanced, for example. The threads 458 of the collar 456 engage thethreads 472 to secure the head 436 to the shaft 432, such that the head436 is oriented relative to the longitudinal axis 434 at an angle α asdescribed above. The shaft 432 may be advanced into the bone 468 so thata desired compressive force is applied to the bone 468, for example.During use, as forces are applied to the head 436 and/or to the shaft432 in a radial direction relative to the longitudinal axis 434, thevariable angle DLS 430 is able to at least partially absorb such forcesby flexing or bending, such that the inner wall 446 moves inside theannular space 448 relative to the outer wall 444 as shown in FIG. 23D,for example.

Is it to be understood that in some exemplary embodiments of thevariable angle DLS 430 may omit the suture fixation holes 476, and/ormay include a suture coupling (not shown) which may be implemented andmay function substantially as described above. Further, in someexemplary embodiments, the variable angle DLS 430 may include more thanone annular space 448 as will be understood by persons of ordinary skillin the art having the benefit of the instant disclosure. Further, insome embodiments, one or more sutures may be wound around the shaft 432and may be compressed against the bone 468 by the head 436 when thevariable angle DLS 430 is implanted into the bone 468, for example.

Referring now to FIG. 24, shown therein is an exemplary embodiment of abone plate assembly 480. The bone plate assembly 480 includes a boneplate 482 and one or more compression screws 484.

The bone plate 482 may be constructed of any suitable bio-inert,biocompatible, or bio-absorbable material, such as stainless steel,titanium, polyethylene, poly-lactic-acid (PLA), poly lactic co-glycolicacid (PLGA), polyurethane, bone tissue, ultra-high molecular weightpolyethylene fibers, epoxy resins, or combinations thereof, for example.

The bone plate 482 may include a plate body 486 having an axis 488, atop surface 490, a bone surface 492, and one or more attachment openings494 formed therein. The attachment openings 494 taper outwardly from thetop surface 490 to the bone surface 492, i.e., the attachment openings494 are narrower at the top surface 490 and wider at the bone surface492. The attachment openings 494 further includes four columns ofthreads 496 formed therein, the threads 496 configured to engage threadsof one or more compression screws 484 as will be described below.

The one or more compression screws 484 include a shaft 498 having alongitudinal axis 500 and a cannula 502 extending therethrough. Theshaft 498 has a proximal end 504 and a distal end 506.

The proximal end 504 includes a head 508 having a convex surface withthreads 510 formed therein and configured to enter an attachment opening494 at the bone surface 492 and threadingly engage one or more of thecolumns of threads 496 in the attachment opening 494.

The distal end 506 has threads 512 configured to engage a bone tissue,such that the compression screw 484 may be retained therein.

In operation, one or more of the compression screws 484 are implantedinto a bone 514 and advanced into the bone 514 such that the head 508 ofthe one or more compression screws 484 is level with, or sits justbelow, the surface of the bone 514. A bone plate 482 is then placedagainst the bone 514 such that one of the attachment openings 494 of thebone plate 482 is aligned with the head 508 of one or more compressionscrews 484. The one or more compression screws 484 are then backed outsuch that the threads 510 of the one or more compression screws 484engage with the threads 496 of the attachment opening 494 in order toattach the bone plate 482 to the one or more compression screws 484. Oneof the one or more compression screws 484 may be oriented such that thelongitudinal axis 500 of the compression screw 484 intersects with theaxis 488 at an angle α, which may vary between about 30° and about 120°,including any ranges and sub-ranges therebetween, for example. Further,one or more of the compression screws 484 may be oriented such that thelongitudinal axis 500 of the compression screw 484 intersects with theaxis 488 at an angle β, which may vary between about 30° and about 120°,including any ranges and sub-ranges therebetween, for example. In someexemplary embodiments of the inventive concepts disclosed herein, theangles α and β may be different, while in other exemplary embodimentsthe angles α and β may be equal or substantially equal to one another.

It is to be understood that while only two compression screws 484 areshown in FIG. 24, a bone plate 482 according to the inventive conceptsdisclosed herein may be attached to a bone 514 with one or morecompression screw 484, for example. Further, a compression screw otherthan the compression screw 484 may be used to attach the bone plate 482to the bone 514, such as a DLS for example. In addition, it will beunderstood that one or more of the suture couplings described above, inparticular the suture coupling 254 b (FIG. 11C), may be used inconjunction with the bone plate system 480.

Further, while the bone plate 482 is shown as having a rectangularcross-section in FIG. 24, a bone plate 482 according to the inventiveconcepts disclosed herein may have any suitable cross-section, such asconcave, convex, rounded-off, or combinations thereof, for example, inorder to minimize adjacent soft tissue injury or irritation.

It is to be understood that the steps disclosed herein may be performedsimultaneously or in any desired order, and may be carried out by ahuman, or by a machine, and combinations thereof, for example. Forexample, one or more of the steps disclosed herein may be omitted, oneor more steps may be further divided in one or more sub-steps, and twoor more steps or sub-steps may be combined in a single step, forexample. Further, in some exemplary embodiments, one or more steps maybe repeated one or more times, whether such repetition is carried outsequentially or interspersed by other steps or sub-steps. Additionally,one or more other steps or sub-steps may be carried out before, after,or between the steps disclosed herein, for example.

Although the inventive concepts disclosed and claimed herein and theadvantages thereof have been described in detail, it should beunderstood that various changes, substitutions and alterations can bemade herein without departing from the spirit and scope thereof asdefined by the appended claims. Moreover, the scope of the presentapplication is not intended to be limited to the particular embodimentsof the process, apparatus, items of manufacture, compositions of matter,means, methods, and steps described in the specification. As one ofordinary skill in the art will readily appreciate from the disclosure ofthe presently disclosed and claimed inventive concepts, variousprocesses, apparatus, items of manufacture, compositions of matter,means, methods, or steps, presently existing or later to be developedthat perform substantially the same function or achieve substantiallythe same result as the corresponding embodiments described herein may beutilized according to the presently disclosed and claimed inventiveconcepts. Accordingly, the appended claims are intended to includewithin their scope such processes, apparatus, items of manufacture,compositions of matter, means, methods, or steps.

What is claimed is:
 1. A compression screw, comprising: a shaft having aproximal end and a distal end, at least the distal end being threaded toengage bone; and a head associated with the proximal end of the shaft,the head having a plurality of outwardly extending projections spacedfrom one another so as to define a plurality of recesses there between.2. The compression screw of claim 1, wherein the projections of the headextend radially outwardly.
 3. The compression screw of claim 1, whereinat least one of the projections of the head has at least one suturefixation hole extending therethrough.
 4. The compression screw of claim1, wherein each of the projections of the head has at least one suturefixation hole extending therethrough.
 5. The compression screw of claim3, wherein each of the shaft and the head has a cannula extendingtherethrough.
 6. The compression screw of claim 1, further comprising asuture coupling having an opening for receiving the shaft and the suturecoupling configured such that the suture coupling is compressed betweenthe head of the screw and the bone when the screw is implanted into thebone and such that the suture coupling extends between adjacentprojections of the head.
 7. The compression screw of claim 6, whereinthe suture coupling is constructed of a bio-inert textile material. 8.The compression screw of claim 1, further comprising a suture couplinghaving an opening for receiving the shaft of the screw and the suturecoupling configured such that the suture coupling is compressed betweenthe head of the screw and the bone when the screw is implanted into thebone and such that the suture coupling extends between adjacentprojections of the head.
 9. The compression screw of claim 8, whereinthe head has a bone engaging surface, and wherein the bone engagingsurface has a plurality of teeth configured to engage the suturecoupling.
 10. The compression screw of claim 8, wherein each of theprojections of the head has a bone engaging surface, and wherein each ofthe bone engaging surfaces has a groove configured such that the groovescooperate to form an annular groove to receive the suture coupling. 11.The compression screw of claim 1, wherein the head has a central openingwith a plurality of thread columns formed therein, and wherein theproximal end of the shaft has a plurality of threads configured toengage the thread columns of the central opening to connect the head tothe shaft.
 12. The compression screw of claim 11, wherein the proximalend of the shaft has a threaded concave collar, wherein the shaftfurther has a neck portion positioned adjacent to the threaded concavecollar, and wherein the head is positioned on the neck portion andconfigured to threadingly engage the concave collar.
 13. The compressionscrew of claim 11, wherein the proximal end of the shaft an inner walland an outer wall defining an annular space between the inner and outerwall, the inner wall comprising a neck portion and a concave collar,wherein the head is positioned on the neck portion and configured tothreadingly engage the concave collar.
 14. A compression screw system,comprising: a screw, comprising: a shaft having a proximal end and adistal end, at least the distal end being threaded to engage bone; and ahead associated with the proximal end of the shaft, the head having aplurality of outwardly extending projections spaced from one another soas to define a plurality of recesses there between; and a screw drivehaving a distal end with a plurality of projections configured to bereceived in the recesses of the head of the shaft in such a way thatrotational force may be transferred from the screw drive to the screw.15. The compression screw system of claim 14, wherein the projections ofthe head extend radially outwardly.
 16. The compression screw system ofclaim 14, wherein at least one of the projections of the head has atleast one suture fixation hole extending therethrough.
 17. Thecompression screw system of claim 14, wherein each of the projections ofthe head has at least one suture fixation hole extending therethrough.18. The compression screw system of claim 16, wherein each of the shaftand the head has a cannula extending therethrough, and wherein the screwdrive has a cannula extending therethrough.
 19. The compression screwsystem of claim 14, further comprising a suture coupling having anopening for receiving the shaft and the suture coupling configured suchthat the suture coupling is compressed between the head of the screw andthe bone when the screw is implanted into the bone and such that thesuture coupling extends between adjacent projections of the head. 20.The compression screw system of claim 19, wherein the suture coupling isconstructed of a bio-inert textile material.
 21. The compression screwsystem of claim 14, further comprising a suture coupling having anopening for receiving the shaft of the screw and the suture couplingconfigured such that the suture coupling is compressed between the headof the screw and the bone when the screw is implanted into the bone andsuch that the suture coupling extends between adjacent projections ofthe head.
 22. The compression screw system of claim 21, wherein the headhas a bone engaging surface, and wherein the bone engaging surface has aplurality of teeth configured to engage the suture coupling.
 23. Thecompression screw system of claim 21, wherein each of the projections ofthe head has a bone engaging surface, and wherein each of the boneengaging surfaces has a groove configured such that the groovescooperate to form an annular groove to receive the suture coupling. 24.The compression screw system of claim 14, wherein the head has a centralopening with a plurality of thread columns formed therein, and whereinthe proximal end of the shaft has a plurality of threads configured toengage the thread columns of the central opening to connect the head tothe shaft.
 25. The compression screw system of claim 24, wherein theproximal end of the shaft has a threaded concave collar, wherein theshaft further has a neck portion positioned adjacent to the threadedconcave collar, and wherein the head is positioned on the neck portionand configured to threadingly engage the concave collar.
 26. Thecompression screw system of claim 25, wherein the proximal end of theshaft an inner wall and an outer wall defining an annular space betweenthe inner and outer wall, the inner wall comprising a neck portion and aconcave collar, wherein the head is positioned on the neck portion andconfigured to threadingly engage the concave collar.
 27. A suturecoupling, comprising: a pliable, bio-inert material configured to definea thin, flat body, the body being conformable to the contour of asurface of a bone when the body is positioned against the surface of thebone.
 28. The suture coupling of claim 27, wherein the body has anopening configured to receive a shaft of a compression screw such thatthe suture body is positionable between a head of the screw and thesurface of the bone.
 29. The suture coupling of claim 28, wherein thebody has a shape in the form of at least one of a ring, a disc, acloverleaf, a cross, and a wedge.
 30. The suture coupling of claim 27,wherein the pliable, bio-inert material is selected from the groupconsisting of: a textile material, a foam material, polyethylene,polyurethane, poly-lactic acid, poly-lactic-co-glycolic acid, ultra highmolecular weight polyethylene fibers, and combinations thereof.
 31. Thesuture coupling of claim 27, wherein the pliable, bio-inert material isa textile material selected from the group consisting of: polyethylene,polypropylene, ultra high molecular weight polyethylene,poly-ether-ether-ketone, poly-ether-ketone-ketone, poly-lactic acid,poly-L-lactide, poly-L/D-lactide, poly-lactic-co-glycolic acid,poly-glucolide, poly-capro-lactone, nitinol, and combinations thereof.32. The suture coupling of claim 30, wherein the textile material is awool-like textile material.
 33. The suture coupling of claim 28, whereinthe body has a reinforced inner edge defining the opening and areinforced outer edge.
 34. The suture coupling of claim 33, furthercomprising at least one suture integrated with the body.
 35. The suturecoupling of claim 34, wherein the suture forms at least one loop. 36.The suture coupling of claim 33, wherein suture is threaded through thebody.
 37. The suture coupling of claim 36, further comprising a needleattached to the suture.
 38. The suture coupling of claim 33 wherein thereinforced inner edge further includes a first rigid reinforcing ring,and wherein the reinforced outer edge further includes a second rigidreinforcing ring.
 39. The suture coupling of claim 28, wherein the bodyhas at least one suture eyelet configured to receive at least one suturetherein.
 40. The suture coupling of claim 39, wherein the suture eyelethas a reinforced edge.
 41. The suture coupling of claim 40, wherein thebody has a plurality of suture eyelets, and wherein the suture eyeletsare arranged in a substantially circular configuration around theopening.
 42. The suture coupling of claim 28, wherein the opening forreceiving the shaft of the screw is a first opening, and wherein thebody has a second opening configured to be inserted over a shaft of asecond compression screw, the second opening being offset a distancefrom the first opening.
 43. The suture coupling of claim 28, wherein thebody is cross-shaped so to be provided with a plurality of protrusion,at least a portion of the protrusions having a length so as to befoldable over at least a portion of the head of the screw.
 44. Thesuture coupling of claim 28, wherein the body has an outer edge and aninner edge defining the opening and a slit extending from the outer edgeto the inner edge.
 45. The suture coupling of claim 44, wherein theouter edge has at least two closure loops positioned adjacent to theslit and configured to receive a suture therethrough.
 46. The suturecoupling of claim 27, further comprising a reinforcement mesh positionedon at least one side of the body.
 47. The suture coupling of claim 28,wherein the body has a narrow end and a wide end.
 48. The suturecoupling of claim 47, wherein the opening is provided adjacent thenarrow end.
 49. The suture coupling of claim 48, wherein the body isprovided with at least one suture eyelet adjacent the wide end.